Efficacy of applied behavioral intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: a systematic review and meta-analysis.
OBJECTIVE
To review the effectiveness of applied behavior intervention (ABI) programs for preschool children with autism spectrum disorder (ASD) in their cognitive, adaptive behavior, and language development.


METHODS
Systematic reviews, randomized or quasirandomized controlled trials (RCT) of ABI delivered to preschool children with ASD were reviewed. Quantitative data on cognitive, language, and behavior outcomes were extracted and pooled for meta-analysis (RevMan 4.2).


RESULTS
Thirteen studies met the inclusion criteria. Six of these were randomized comparison trials with adequate methodologic quality (PEDro >or= 6). Meta-analysis of 4 studies concluded that, compared with standard care, ABI programs did not significantly improve the cognitive outcomes of children in the experimental group who scored a standardized mean difference (SMD) of 0.38 (95%CI -0.09 to 0.84; P = .1). There was no additional benefit over standard care for expressive language; SMD of 0.37 (95%CI -0.09 to 0.84; P = .11), for receptive language; SMD of 0.29 (95%CI -0.17 to 0.74; P = .22) or adaptive behavior; SMD of 0.30 (95%CI -0.16 to 0.77; P = .20).


CONCLUSIONS
Currently there is inadequate evidence that ABI has better outcomes than standard care for children with autism. Appropriately powered clinical trials with broader outcomes are required.
Spreckley
Michèle
M
Uncle Bobs Child Development Centre, Department of Developmental Medicine, The Royal Children's Hospital, Melbourne, Australia. michele.spreckley@rch.org.au
Boyd
Roslyn
R
D000223:Adaptation, Psychological; D001321:Autistic Disorder / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy; D002675:Child, Preschool; D003071:Cognition; D006801:Humans; D007804:Language Development; D017063:Outcome Assessment, Health Care